VA photograph

VASNHS suicide prevention case managers speak with UNLV veterans at a student orientation event.

The Department of Veterans Affairs’ top clinical priority is reducing the suicide rate among veterans.

However, achieving this goal is difficult as 14 of the estimated 20 veterans who are lost to suicide each day have either never connected to VA care or haven’t recently accessed VA services.

As such, the VA relies on public-private partnerships to inform and educate veterans, family members, caregivers and other stakeholders of resources available before and during a crisis.

Since October 2017, the VA Southern Nevada Healthcare System’s Suicide Prevention team has conducted more than 350 outreach events locally in support of this effort, and looks to make more improvements in 2019.

“While veterans always can reach someone on the national VA 24-hour Veterans Crisis Line, it’s through local efforts where real suicide prevention takes place,” said Paul Frederickson, who has worked as a VASNHS suicide prevention case manager for the past four years. “The crisis line handles the immediate emergencies, but it’s up to us to follow-up, make sure they get hospitalization, medication, mental health treatment or whatever else they need. After we receive notification of a local veteran in crisis, we have one business day to begin the follow-up, and should be finished within 72 hours. With some of our veterans unable to receive phone calls, the process can be very difficult, but with more people on our team, it’s been more possible to do that.”

Up until late 2017, Frederickson was the only individual at VASNHS solely dedicated to suicide prevention. Since then, the suicide prevention team has grown to four, and will soon include a fifth person. With the increase in manpower, VASNHS has been able to increase outreach through a number of programs.

One of the first big initiatives is Operation S.A.V.E., a two-hour gatekeeper training program provided by VA suicide prevention coordinators to Veterans and those who serve veterans, both within the VA and at community hospitals and clinics. The course consists of education on veteran-specific issues, identifying risk factors for suicide, and instruction of the S.A.V.E. model (Signs of suicide, Asking about suicide, Validating feelings, Encouraging help and Expediting treatment.)

According to Frederickson, suicide is statistically more prevalent in rural communities, especially among veterans. As such, another VASNHS suicide prevention initiative is rural outreach. “Our catchment area is geographically huge,” Frederickson said. “It goes as far north as Ely, Nev., down to parts of southern California, as well as into portions of northwest Arizona and southwest Utah.

“A problem that we’ve found in these rural areas is that veterans don’t have the money or reliable transportation to drive two or three hours to get to a hospital,” Frederickson continued. “So the S.A.V.E. training we’re offering is helping community members help their fellow citizens in an effort to lower the suicide risk. Yes, you try to get them seen by a professional, but there isn’t always a professional readily available. Ninety-nine percent of the battle against suicide is building those relationships, so in these smaller communities, if we can teach them to take care of themselves, then we can bring down the suicide rates. That has been our focus now that we have a larger staff.

VASNHS’ suicide prevention outreach efforts have expanded beyond clinics and hospitals. “We try to visit establishments that veterans who are having issues may frequent, such as liquor stores, marijuana dispensaries and gun shops,” Frederick said. “We talk with staff, provide education and pass out suicide prevention materials and cards with the Veterans Crisis Line.”

According to a recent VA study of veteran suicides between 2006 and 2016, the suicide rate among veterans ages 18–34 has increased substantially in recent years. While many of these veterans have served during the conflicts in Iraq and Afghanistan, Frederickson said they are statistically less likely to seek out VA care. The VASNHS suicide prevention team has tried to bridge that gap by seeking out student-veterans.

At the University of Nevada-Las Vegas, VASNHS is working with Rebel Vets, a student-led veteran support group, to reach out to those at-risk on campus. “Getting used to the university life can be overwhelming for some veterans, and we need a support organization on campus to ensure that if they have issues, they know where they can go to get help,” said Alan Shockley, a VA vocational rehabilitation specialist working on the UNLV campus. “There have been too many suicides nationally, and unfortunately we have seen it locally as well. We want to do what we can to make sure that number is zero in the future.”

Whether it’s providing training, distributing promotional materials, or conducting rural outreach, Frederickson said the extra manpower has helped the VA expand its local efforts. “The more people and organizations we can make contact with, and either educate or distribute materials to, the more likely we are to reach those who are at risk and connect them to resources,” he concluded.

For veterans in a crisis, the VA Southern Nevada Healthcare System encourages them to visit the closest VA medical facility or nearest emergency room. In Southern Nevada, all VA sites of care provide same-day services for veterans with urgent mental health needs during regular business hours. Additionally, the Emergency Department at the North Las Vegas VA Medical Center is available around the clock. Veterans may also receive help 24/7 via the Veterans Crisis Line by dialing 1-800-273-8255 and pressing option one.